Urinary bacterial pathogens and their antimicrobial susceptibility profile for the years 2005-2007 in St Kitts

OBJECTIVE

The purpose of this study is to review bacterial isolates from cases of urinary tract infection (UTI) and their antimicrobial susceptibility pattern for the years 2005-2007 in St Kitts. It is hoped that the study will be of use in the treatment of cases of UTI in St Kitts.

METHODS

The laboratory records at St Francis Hospital, Basseterre, St Kitts, for bacterial isolates from cases of urinary tract infection and their susceptibility profiles for three years, 2005-2007, were retrospectively reviewed and compared.

RESULTS

A total of 595 isolates of 13 species of pathogenic bacteria were recovered from cases of UTI. Escherichia coli was the predominant species recovered each year. Among the other species frequently recovered were Citrobacter spp, Enterobacter spp, Klebsiella pneumoniae and Pseudomonas aeruginosa.

CONCLUSION

This study, the first of its kind from St Kitts serves to emphasize that treatment of UTI should be instituted generally on the basis of antimicrobial susceptibility tests.

Sporotrichosis in north-east India

Reports on the occurrence of sporotrichosis in some parts of north-east India are scarce. We report here five cases of lymphocutaneous sporotrichosis from north-east India, including one from Sikkim State and four from distant places in the north-eastern part of West Bengal. All patients were full or part-time farmers or gardeners. Diagnosis of sporotrichosis was confirmed by isolation of Sporothrix schenckii in culture and in vitro conversion of the isolates to yeast form. The cases were treated with 50% solution of potassium iodide.

Isolation of Cryptococcus gattii and Cryptococcus neoformans var. grubii from the flowers and bark of Eucalyptus trees in India

The association of Cryptococcus gattii with Eucalyptus trees has been well established. Here we report the isolation of both C. gattii and Cryptococcus neoformans var. grubii from the flowers and bark of Eucalyptus trees in India. We investigated a total of 233 samples of Eucalyptus trees: 120 flowers, 81 fragments of bark, and 32 leaves. C. gattii was isolated from two samples of flowers of Eucalyptus terreticornis. C. neoformans var. grubii was recovered twice from the bark of Eucalyptus camaldulensis, initially from one of three samples, and again 2 months later, from one of four samples collected beneath the canopy of the tree. The primary isolation medium was Nigerseed agar, and brown colonies were presumptively identified as C. gattii or C. neoformans. The species identification was confirmed by morphological and biochemical characteristics. Using the Crypto-Check kit (Iatron, Tokyo, Japan), the first two isolates were identified as serotype B (C. gattii) and the other two were serotype A (C. neoformans var. grubii). PCR analysis of the isolates of C. neoformans var. grubii revealed that they possessed the MATalpha mating type allele. Molecular typing by amplified fragment length polymorphism markers indicated that both isolates of C. neoformans var. grubii possessed the same genotype. This study demonstrates that C. neoformans var. grubii, as well as C. gattii, may be associated with Eucalyptus trees.

Cutaneous phaeohyphomycosis caused byCladosporium oxysporumand its treatment with potassium iodide

Human infections due to Cladosporium oxysporum are rarely known. This case report describes cutaneous phaeohyphomycosis cause by C. oxysporum in a 30-year-old female. Lesions presented as multiple coalescing ulcers on the left foot. Diagnosis was based on histology and recovery of the fungus in culture. The patient was successfully treated with potassium iodide.

An outbreak of candidemia due to Candida tropicalis in a neonatal intensive care unit

An outbreak of candidemia due to Candida tropicalis involving 16 neonates (gestational age 28-36 weeks) is reported. All infants had received hyperalimentation and at least one course of antibiotics. The commonest clinical manifestations included episodes of acute respiratory distress and lack of response to antibacterial antibiotic therapy. Candida tropicalis was recovered from blood in all the 16 infants and urine cultures were positive in 14 infants. Environmental sampling yielded C. tropicalis from one each of the blankets and mattresses used for neonates. Four of five urinary tract isolates and both environmental isolates genotyped by arbitrarily primed-PCR with several random primers were shown to belong to the same genotype.

Oropharyngeal carriage of Candida species in HIV-infected patients in India

The present investigation represents the first study of oropharyngeal carriage of Candida and other yeasts in HIV-infected patients in India. One hundred and fifty HIV-positive patients were investigated by culturing their swish samples on plates of CHROMagar Candida. Ninety-eight patients (65.3%) were positive for Candida and four (2.7%) were positive for other yeasts. Among them, the first Indian C. dubliniensis isolate has been recovered. Molecular typing of selected C. albicans isolates by AP-PCR revealed two major genotypes based on the banding patterns. The susceptibilities of 30 Candida isolates to five antifungal agents including the new triazole voriconazole were determined in a micro-dilution test, according to the NCCLS protocol M 27. All the 22 C. albicans isolates were susceptible to five antimycotic agents (flucytosine, amphotericin B, fluconazole, voriconazole and itraconazole) except one isolate (VPCI-122), which was resistant to flucytosine (MIC > or = 64 mg l-1). The azole-resistant isolates reported here endorse the role of antifungal susceptibility testing whenever antifungal treatment with azoles is planned.

Ecology and taxonomy of pathogenic aspergilli

Aspergillus fumigatus and related species are widely distributed in nature. The majority of the species belonging to this genus are saprophytic in nature. Only a few species including A. fumigatus are capable of causing diseases in man. These opportunistic agents may cause infection or allergy in susceptible individuals. These fungi also cause diseases in animals, birds, and in plants. In addition, some of the enzymes and metabolic products have tremendous value in industry. A few of the Aspergillus species produce potent toxins of the aflatoxin family, which can cause cancer. Toxic death due to aflatoxins has been reported in humans, animals, and birds. There are currently about 180 recognized species of Aspergillus, and these species are placed in 6 subgenera, which are further divided into several sections. The telemorphs belonging to the genera are Chaetosartorya, Dichlanea, Eurotium, Emericella, Fennellia, Hemicarpentales, Neosartorya, Petromyces, Sclercleisia, and Warcupiella. This review presents a concise overview of the ecology, taxonomy, and genetics of Aspergillus species including their role in plant, animal, and human diseases, production of toxic metabolites, and molecular methods for their identification.

Effect of contraceptives on the prevalence of vaginal colonization with Candida species in Edo State, Nigeria

High vaginal swabs (HVS) obtained from 500 volunteers in Edo State, Nigeria which comprised 394 contraceptive users and 106 non-contraceptive users were screened for the prevalence of Candida species using standard procedures. Results revealed the isolation of Candida species in 246 of volunteers. These included Candida albicans 174 (38.4%), Candida pseudotropicalis 20 (4%), Candida stellatoidea 15 (3%), Candida krusei nine (1.8%), Candida guilliermondii 12 (2.4%), Candida tropicalis 11 (2.2%) and Candida glabrata five (1%). Of the 394 contraceptive users, 203 (51.5%) had Candida species isolated from them compared to 43 (40.6%) from 106 non-contraceptive users. There was significant relationship (P<0.001) between the type of contraceptive used and the prevalence of vaginal colonization. Age and marital status of the volunteers sampled had significant relationship (P<0.001) with the prevalence of vaginal colonization. Results have revealed an association between use of contraceptive and the prevalence of vaginal colonization in our environment.

Otomycosis in Nigeria: treatment with mercurochrome

Seventy-two mycologically proven cases of otomycosis (38 males, 34 females) aged 8-80 years were investigated. Aspergillus niger was the commonest aetiological agent (43.1%) followed by Candida spp. (22.2%), A. flavus (19.4%) and A. fumigatus (15.3%). Three topical drugs, namely mercurochrome, clotrimazole and locacorten-vioform, were evaluated for otomycosis therapy in separate groups of 24 patients each. Mercurochrome was found to be the most efficacious in terms of healing, relief from symptoms of the disease and production of negative fungal cultures. Mercurochrome is recommended as a safe and economical drug for the topical treatment of otomycosis in developing countries like Nigeria.

Training medical myocologists in developing countries

Although there has over recent years been a marked rise in the incidence of serious fungal infections, many of which are prevalent in developing countries, few facilities exist for diagnosis and research in medical mycology. In most countries, medical mycology is not taught adequately to medical students and consequently there is little awareness of the importance of fungal infections. Model teaching programmes need to be developed. Practical knowledge of mycoses, their diagnosis and treatment and also basic mycology can be disseminated through well-constructed courses and workshops. Formalized training in mycology research also needs to be introduced. To achieve all of this, expertise and additional resources need to be made available. In this regard, ISHAM can and should help.

Histoplasmosis in Africa: a review

Classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum, and African histoplasmosis caused by H. capsulatum var. duboisii are both endemic in Africa. In South Africa, only classical histoplasmosis caused by Histoplasma capsulatum var. capsulatum is known to occur and cases are seen frequently. It occurs sporadically in several other African countries. Histoplasma capsulatum var. capsulatum is known to occur naturally in caves inhabited by bats in some parts of South Africa, namely, Transvaal and Cape province, Zimbabwe and Tanzania. Outbreaks of histoplasmosis have been reported in cave explorers. Surveys of histoplasmin skin sensitivity carried out in Africa have shown the rate of positive reactors to be from 0.0% to 28%. African histoplasmosis caused by H. capsulatum var. duboisii is prevalent in Western and Central Africa, and in the island of Madagascar between the Kalahari and Sahara deserts, that is between latitudes 20 degrees North and 20 degrees South of the Equator. A natural reservoir of this fungus in soil admixed with bat guano has been found in a bat cave in a rural area, viz. Ogbunike in Anambra State of Nigeria. The clinical features and epidemiology of the two forms of the disease in Africa are reviewed.

Antibodies to antigens of Histoplasma, Blastomyces and Candida in HIV patients and carriers in Nigeria

Serum samples from 60 subjects with confirmed HIV-1 infection including 28 AIDS patients and 32 carriers were examined by immunodiffusion for precipitating antibodies to antigens of Histoplasma, Blastomyces and Candida. Seven of the subjects, four patients and three carriers, showed antibodies to histoplasmin prepared from mycelial cultural filtrate of Histoplasma capsulatum var. capsulatum and H. capsulatum var. duboisii although without any clinical signs of classical or African histoplasmosis. Another eight subjects comprising five patients and three carriers demonstrated antibodies to yeast cell antigen of Candida albicans; three of the patients had oral lesions clinically suggestive of Candida infection. None of the serum samples revealed antibodies to "A" antigen (yeast cell antigen) of Blastomyces dermatitidis.

Case report. Meningitis due to Cryptococcus neoformans var. neoformans serotype AD associated with pulmonary tuberculosis

A case of meningitis in a 38-year old male with pulmonary tuberculosis is described. Cryptococcus neoformans was isolated from the cerebrospinal fluid. The isolate belonged to variety neoformans serotype AD. The patient died before any antimycotic therapy could be instituted.

Case report. Subcutaneous phaeohyphomycosis due to Cladosporium cladosporioides

A case of subcutaneous phaeohyphoymycosis caused by Cladosporium cladosporioides in a 25-year-old male is described. The clinical presentation was an elevated scaly suppurating lesion with sinuses on the right leg. The lesion healed completely with oral fluconazole therapy. The present report constitutes the first record of cutaneous or subcutaneous infection due to Cl. cladosporioides from India.

Some deep mycoses diagnosed by histopathology in South Eastern Nigeria

Twenty-three cases of deep mycoses were histologically diagnosed in 6500 surgical biopsy specimens examined during a three year period (1985-1988) in the Department of Pathology, University of Calabar Teaching Hospital, Calabar, Nigeria. These included 12 cases of African histoplasmosis, four of mycetoma, four of actinomycetoma, two of paranasal aspergilloma, and one of zygomycosis due to Conidiobolus coronatus (rhinoentomophthoromycosis). Involvement of tooth gum and colon in one case each of African histoplasmosis, and of maxillary sinus in two cases of paranasal aspergilloma were unusual clinical manifestations. The need for greater awareness of deep mycoses and for provision of adequate laboratory facilities in Nigeria is emphasized.

A review of zygomycosis due to Basidiobolus ranarum

Zygomycosis due to Basidiobolus ranarum (entomophthoromycosis basidiobolae, subcutaneous zygomycosis, subcutaneous phycomycosis, basidiobolomycosis) is a granulomatous infection of the skin and subcutaneous tissues characterized by the formation of fluctuant firm and non-tender swellings, generally on the extremities, trunk and rarely other parts of the body. The causative agent is common in soil, decaying vegetable matter, and the gastrointestinal tracts of amphibians, reptiles, fish and bats. It is presumed that infection is acquired through exposure to B. ranarum following minor trauma to skin or insect bites. The disease usually occurs in children, less often in adolescents and rarely in adults. Males are much more frequently affected than females. Laboratory diagnosis is based on histopathology and culture. The typical histopathological feature is the presence of thin-walled, broad often aseptate hyphae or hyphal fragments with an eosinophilic sheath, frequently phagocytized within giant cells. Basidiobolus ranarum is known to produce several enzymes, e.g. lipase and protease that probably play roles in the pathogenesis of infections caused by this mould. An immunological test has been developed for specific diagnosis of the disease. Though potassium iodide (KI) has been the traditional drug employed in the treatment of infections by B. ranarum, several other drugs, viz amphotericin B, cotrimoxazole, ketoconazole, itraconazole and fluconazole have been successfully tried.

Some emerging food and water borne pathogens

Emerging pathogens are those infective organisms whose incidence has recently increased or is likely to increase during the next two decades due to changes in demography, food habits, food technology, commerce, water sources and environmental factors. Some important emerging food and water borne bacterial pathogens include Listeria monocytogenes, Campylobacter jejuni, Yersinia enterocolitica, Salmonella enteritidis, Escherichia coli O157: H7, Vibrio cholerae biotype E1 Tor Serotype 0139, Vibrio parahaemolyticus and Aeromonas hydrophila, A. sobria, and A. caviae. The prevalence, ecological relationships of these organisms, their transmission through food, water and other environmental sources, and role of their virulent factors in the pathogenesis of infections and their public health significance is discussed in this paper with special reference to the situation in India.

African histoplasmosis: report of two patients treated with amphotericin B and ketoconazole

Two patients with African histoplasmosis manifested by ulcers and cutaneous swellings are described. The inguinal lymph nodes were also involved in one patient. Treatment with amphotericin B combined with ketoconazole was successful.

Cerebral phaeohyphomycosis: report of a case from Nigeria

A fatal case of cerebral phaeohyphomycosis in a 45-year-old Nigerian woman is described. The main clinical features were loss of vision, constant severe headache and the presence of a tumorous mass in the brain as detected on operation. Histology revealed granulomatous tissue reaction with fungal elements suggestive of Xylohypha bantiana.

African histoplasmosis: report of four cases from north-eastern Nigeria

Four cases of African histoplasmosis with lesions of the skin, subcutaneous tissues and lymph nodes diagnosed histologically are described from the Borno State of Nigeria. Three of the cases were autochthonous to this State, whereas the fourth one originated from the Anambra State of Nigeria. These cases constitute the first record of African histoplasmosis from the arid zone of the north-eastern part of Nigeria.

African histoplasmosis: osteomyelitis of the radius

Bone lesions in African histoplasmosis caused by Histoplasma capsulatum var, duboisii, without other signs of the infection, are often misdiagnosed as cancer. A case of isolated osteomyelitis due to this fungus in a 30-year-old woman is described. Diagnostic and therapeutic problems of isolated bone lesions in African histoplasmosis are discussed. A high diagnostic index of African histoplasmosis is advocated in isolated bone lesions in the endemic region of this disease.

Keratin degradation by Scytalidium species and Fusarium solani

The keratin degradation capability of some non-dermatophytic filamentous fungi, viz Scytalidium dimidiatum types A and B, S. hyalinum, S. japonicum and Fusarium solani, was investigated using nail clippings and keratin powder as substrates. Representative isolates of the dermatophytes Trichophyton rubrum and T. mentagrophytes were also tested. The two morphological types of S. dimidiatum were almost equally effective in the degradation of substrates, 42-43% nail clippings and 24-26% keratin. Scytalidium hyalinum and S. japonicum degraded 40% and 38% of nail clippings respectively. Degradation of keratin was insignificant. In the case of F. solani, nail clippings were degraded 43% and keratin 20%. The dermatophytes caused much higher degradation of nail clippings (70-73%) and keratin (42-52%).

African histoplasmosis: a review

African histoplasmosis caused by Histoplasma capsulatum var. duboisii is an important deep mycosis endemic in Central and West Africa and in the island of Madagascar. The disease is characterized by presence of granulomatous lesions in the skin, subcutaneous tissues and bones. Lungs and other internal organs are rarely involved. The natural reservoir of the etiological agent has only been recently discovered in a bat cave in Nigeria. The status of asymptomatic infection is not certain. Investigations on skin and serum reactivity have suggested frequent prevalence of asymptomatic infections due to H. capsulatum var. duboisii among the residents in the vicinity of the cave microfocus of the fungus. The exact portal of entry into the body is not known, but inhalation into the lungs and direct inoculation in the skin have been incriminated. Laboratory diagnosis is confirmed by in vitro conversion into large yeast forms (8-15 mum in diameter) and by the demonstration of these forms within giant cells of tissues of experimentally infected animals There are no major clean-cut physiological differences between the two varieties, viz. capsulatum and duboisii. The cell wall of H. capsulatum var duboisii contains a glucan with beta 1-4 linkages in addition to a galactomannan shared with H. capsulatum var. capsulatum. Like the var. capsulatum var. duboisii has marked proteinase and collagenase activities in both mycelial and yeast forms, suggesting a possible pathogenic role for these enzymes. Both varieties have a common exoantigen. The yeast form of H. capsulatum var. duboisii contains the antigen found in the serotype 1,4 of var. capsulatum. A monoclonal antibody test has been developed that can recognize some epitopes in H. capsulatum var. capsulatum but not in the var. duboisii. There is need to develop specific serological diagnosis for the disease. Also there should be greater international awareness about African histoplasmosis. Amphotericin B and several antimycotic azoles like ketoconazole, itraconazole and fluconazole have been successfully employed for treatment.

In vitro interactions between Histoplasma capsulatum var. duboisii and other fungi

Histoplasma capsulatum var. duboisii has only recently been shown to occur naturally in soil admixed with bat guano in a bat cave. We report our observations on the in vitro interaction of Histoplasma capsulatum var. duboisii with other fungi recovered from the same habitat or other sources by employing co-culture technique and by investigating antibiosis between H. capsulatum var. duboisii and other fungi. The range of interactions varied from total overgrowth of Histoplasma by Aspergillus fumigatus and Microsporum gypseum, through partial antagonism by Lecythophora mutabilis, to mutual inhibition by Wangiella dermatitidis. Those fungi that exhibited a competitive advantage in terms of growth did not affect the viability of Histoplasma. Lysis and mycoparasitic structures were not observed in the co-cultures. However, the cultural filtrate of Chrysosporium indicum inhibited the growth of the Histoplasma strains. The results suggest the ability of H. capsulatum var. duboisii to co-exist with a variety of other potentially pathogenic and non-pathogenic fungi in an ecological niche.

Sulconazole in the therapy of dermatomycoses in Nigeria

A 1% cream of sulconazole nitrate, an imidazole derivative, was used to treat 38 patients with diverse clinical types of dermatomycoses, including 16 cases of pityriasis versicolor, 14 of dermatophytosis (tinea pedis, tinea cruris, tinea corporis), two of balanoposthitis due to Candida albicans, another two of candidosis of the groin, one each of groin and foot infection due to Trichosporon beigelii and one case each of lesions of the hand and trunk caused by Petriellidium boydii and Scytalidium hyalinum respectively. A complete cure was achieved in 91% of patients, with resolution of the lesions in the majority within 2-4 weeks. There were only two relapses. Sulconazole is recommended as an effective drug for topical treatment of superficial fungal infections of the skin.

Extracellular proteolytic enzyme activity of Histoplasma capsulatum var. duboisii

Histoplasma capsulatum var. duboisii is the etiological agent of African histoplasmosis, an important deep mycosis in West Africa. Not much is known about the physiological properties of this fungus. This communication reports on the extracellular proteolytic enzyme activity of this fungus. Five isolates of this fungus tested hydrolyzed azocasein and bovine serum albumin at pH 6.8 and 8.0. Assay of the crude enzyme showed that proteolytic activity increased with age and peaked on the 10th day and then again on the 13th day for the yeast form, and on the 11th day of growth for the mycelial form. The optimum temperature and pH for maximum enzyme activity were 35 degrees C and 6.8 respectively. The proteinase activity was more pronounced with the yeast form than with the mycelial form. The action of enzyme inhibitors suggested the presence of an aspartyl proteinase.

Skin and serum reactivity among humans to histoplasmin in the vicinity of a natural focus of Histoplasma capsulatum var. duboisii

The epidemiology of histoplasmosis duboisii (African histoplasmosis) is not well understood. The present study was carried out to investigate the prevalence of skin sensitivity and to determine by immunodiffusion the presence of antibodies among humans to histoplasmin around a recently discovered natural focus of Histoplasma capsulatum var. duboisii in a bat cave in Ogbunike in the Anambra State of Nigeria. Out of the 40 subjects, all young adults aged 18-30 years, comprising cave guides, traders and farmers examined in the immediate vicinity of the cave, 14 (35.0%) gave a positive skin test. In another population of the same age group, comprising 620 persons, viz. traders, farmers, palm oil workers and some patients attending rural clinics, examined in other nearby areas in Anambra State, 55 (8.8%) reacted positively to histoplasmin. In the immunodiffusion tests, 2 (2.08%) of the 96 school children and 17 (9.4%) of the 181 young adults, including farmers, palm oil workers and traders tested amongst the population around the cave, demonstrated precipitating antibodies to histoplasmin in their sera. Only 5 (0.79%) of the 630 adults of the same age group with similar occupations examined from other areas in Anambra State had precipitating antibodies. Out of another 50 subjects examined, viz.; wood workers, traders, farmers, and school teachers in Nsukka in the Enugu State, two (4.0%) demonstrated antibodies. It is suggested that asymptomatic infections due to the duboisii variety of H. capsulatum may be common in the human population around the cave. A diligent search with the help of local hospitals and public health officials may reveal clinical cases of histoplasmosis duboisii with cutaneous and systemic lesions.

Fluconazole in the therapy of tropical deep mycoses

A clinical study was conducted to test the efficacy of fluconazole in the treatment of tropical deep mycoses. Two out of four patients with zygomycosis due to Conidiobolus coronatus who were treated with the drug were completely cured; the other two patients exhibited considerable improvement but could not be followed up. Two patients with eumycetoma, one due to an Acremonium sp. and one due to Pseudallescheria boydii, were treated successfully, whereas another patient with a eumycetoma caused by an unidentified fungus could not be followed up. A complete cure was achieved with one patient with African histoplasmosis and one with candiduria. A case of cerebral phaeohyphomycosis due to Cladosporium sp. showed some improvement but the patient later developed meningitis and died.

Antibiotic sensitivity of isolates of Pseudomonas aeruginosa in Buraidah, Saudi Arabia

A study was carried out to determine the pattern of in vitro antibiotic sensitivity of a cross section of the isolates of Pseudomonas aeruginosa recovered from diverse clinical sources during a one year period. One hundred and eighty-six isolates were investigated by disc diffusion method employing multidiscs. Majority of the isolates were sensitive to amikacin (89.7%), tobramycin (75.81%), norfloxacin (68.48%), piperacillin (68.25%), and ceftazidime (58.81%). Other antibiotics were effective for a lesser number of isolates. A few isolates were simultaneously resistant to several antibiotics, viz. gentamicin, carbenicillin, tobramycin, ceftazidime and augmentin. The significance of the findings is discussed.

Microbiological studies on cases diagnosed as typhoid/enteric fever in south-east Nigeria

Eight hundred and nine patients suspected of having typhoid/enteric fever were investigated. Enteric fever bacilli (Salmonella typhi and S. paratyphi) were cultured from stool samples of 128 (16%) patients. Serological evidence of typhoid fever was obtained in 83 (13%) of 620 of the patients examined by the Widal test. The antibody titres ranged from 1:160 to 1:1280. A higher proportion of paratyphoid infection over typhoid infection was recorded both by culture (56%) and by the Widal test (63%). The predominant serotype was paratyphi C. Non-typhoid Salmonellae were recovered from stool samples of 60 patients, comprising five serovars, namely, S. typhimurium-22 strains, S. enteritidis-15, S. hardar-9, S. virchow-5, S. bredeney-3, and 6 non-typable strains. Shigella sonnei and S. flexneri were detected in diarrhoeic and semi-formed stools of 19 (2.3%) of the typhoid suspects. It is clear from the results of the study that though typhoid is endemic in South-East Nigeria and the number of cases may rise at certain periods of the year, the news of a current wave of epidemic of typhoid seem unfounded.

The aetiological agents of superficial cutaneous mycoses in Jos, Plateau State of Nigeria

A survey of superficial skin mycoses was carried out among miners and office workers employed in different establishments in Jos, Nigeria. Mycotic infection was demonstrable by microscopy and culture in 45 (10.4%) subjects: 20 males and 25 females. Malassezia furfur was the predominant aetiological agent, followed by Candida albicans and Trichophyton soudanense. Other aetiological agents frequently recovered were T. rubrum., T. mentagrophytes., Microsporum audouinii and Trichosporon beigelii.

Rhinosporidiosis in Saudi Arabia: report of four cases

Four cases of rhinosporidiosis occurring in Indian expatriate workers in Saudi Arabia are described. The prevalence of such cases in other countries of the Arabian Gulf is reviewed.

A natural focus of Histoplasma capsulatum var. duboisii is a bat cave

The natural reservoir of Histoplasma capsulatum var. duboisii, the etiological agent of histoplasmosis duboisii (African histoplasmosis) is not yet known. We report the isolation of H. capsulatum var. duboisii from soil admixed with bat guano and from the intestinal contents of a bat in a sandstone cave in a rural area, Ogbunike in Anambra State of Nigeria. Eight of 45 samples of soil admixed with bat guano yielded H. capsulatum var. duboisii. Of the 35 bats belonging to the species Nycteris hispida and Tadirida pumila examined, only one (N. hispida) yielded this fungus from its intestinal contents. Identification of the isolates as Histoplasma was confirmed by exoantigen tests and by mating with tester strains of H. capsulatum. In vitro conversion to large yeast from suggestive of H. capsulatum var. duboisii was obtained on brain heart infusion agar supplemented with sheep blood and glutamine or cysteine. Pathogenicity tests with mice for all the isolates confirmed their identity by the demonstration of large yeast forms (8-15 microns in diameter) within giant cells in the infected tissues. Investigations on the possible occurrence of human infections in the area are in progress.

Isoconazole nitrate in the treatment of tropical dermatomycoses

A total of 54 patients with culturally proven tropical dermatomycoses, comprising 23 with various types of dermatophytoses, one with foot infection due to Trichosporon beigelii and one with foot infection due to Geotrichum candidum, two with candidosis of the groin and 27 with pityriasis versicolor, were included in a clinical trial of efficacy of 1% isoconazole cream (Travogen, Schering, Berlin, Germany). Five patients were not evaluable. A clinical and mycological cure was achieved in 29 cases in 3-4 weeks. In 15 (31%) of the remaining patients treatment was required for 5-6 weeks, while another three patients required treatment for 8 weeks. In two patients the disease proved to be resistant to treatment with the drug.

Occurrence of thermophilic actinomycetes in natural substrates in Nigeria

Thermophilic actinomycetes were isolated from 163 (48.95%) of 333 samples of vegetable substrates and soil from different sites in Anambra and Enugu States in Nigeria. Thermoactinomyces (Tha.) vulgaris was the most common, occurring in 32.4% of samples while Tha. thalpophilus was isolated from 20.1%. Tha. sacchari, Saccharomonospora (Sam.) viridis and Saccharopolyspora (Sap.) rectivirgula were isolated from 3-10.5% of the samples examined. Streptomyces (Stm.) thermovulgaris occurred in 2.7% and Thermomonospora spp. in 0.6% of samples. Except for Stm. thermovulgaris and, perhaps, Thermomonospora spp., all the species isolated are known to be allergenic in man. The five known allergenic species were abundant in hay and maize silage. T. vulgaris and T. thalpophilus were also frequently isolated from rice straw. Tha. vulgaris, Tha. thalpophilus and Sap. rectivirgula were all most numerous in hay while Tha. sacchari was most numerous in maize silage. The widespread occurrence of thermophilic actinomycetes in Nigeria emphasizes the need for investigation of their role in allergic respiratory disorders.

Isolation of Lecythophora mutabilis and Wangiella dermatitidis from the fruit eating bat, Eidolon helvum

Lecythophora mutabilis was isolated from the lungs of 3 and from the liver of 2 bats, Eidolon helvum a fruit eating species. Wangiella dermatitidis was recovered from the liver of 2 bats of the same species. The isolates were pathogenic for laboratory mice when injected by subcutaneous, intraperitoneal and intravenous routes. W. dermatitidis was neurotropic in the mice injected intravenously.

Dermatomycoses among industrial workers in Cross River State, Nigeria

A survey of dermatomycoses was carried out amongst industrial workers in three different factories during the period 1987-1988. A total of 194 workers were screened, out of which 54 proved to be mycologically positive by microscopy and/or culture. Incidence was apparently highest amongst workers in a cement factory (Calcemco, 33.3%) followed by those in a wood factory (Seromwood, 30.8%) and a rubber factory (CREL, 26.2%). Pityriasis versicolor was the predominant clinical type of dermatomycosis, followed by tinea pedis. A total of 51 fungal organisms were identified. Malassezia furfur was the most prevalent causative agent (74.4%) followed by Trichophyton soudanense (5.8%), T. rubrum (3.9%) and Epidermophyton floccosum (3.9%). Other species identified were one isolate each of T. tonsurans, T. mentagrophytes, T. verrucosum, Candida tropicalis, Candida spec. and Geotrichum candidum.

Isoconazole nitrate versus clotrimazole in foot and nail infections due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes

A total of 40 coal miners, 35 with culturally proven mycotic infections of the feet and 5 with similarly proven infections of toenails due to Hendersonula toruloidea, Scytalidium hyalinum and dermatophytes, were treated with 1% cream of either isoconazole nitrate (Travogen) or clotrimazole (Canestan) for 4 weeks. The clinical cure rates for the isoconazole-treated group for itching, inflammation, scaling and maceration in the cases of foot infections were 89, 88, 83 and 83% respectively. For the clotrimazole-treated group, the cure rates were 76, 71, 82 and 80% respectively, for the similar symptoms. Toe web was the commonest site of infection and also most easily treated with either clotrimazole or isoconazole. The clinical and mycological cure rates 6 weeks after treatment were 80% for the isoconazole-treated group and 70% for the clotrimazole-treated group but the difference was not statistically significant (P > 0.01). None of the cases of toenail infection could be cured by treatment with either of the two drugs.

Entomophthoromycosis due to Conidiobolus

Entomophthoromycosis due to Conidiobolus coronatus is a granulomatous infection characterized by lesions that originate in the inferior turbinate, spread through ostia and foramina to involve the facial and subcutaneous tissues and paranasal sinuses. The majority of the cases have been described from areas of tropical rainforest in West Africa, agricultural and outdoor workers (aged 20-60 years) being the ones most frequently affected. The fungus is common in soil and decaying vegetation. Infection probably occurs by implantation of the spores of the fungus in nasal mucosa. C. incongruus is a rare agent of the disease, so far known only from two cases with lesions involving the pericardium, mediastinum, lungs, liver, oesophagus and jejunum. C. coronatus is known to cause a clinically similar disease in horses, mules, a dolphin and a chimpanzee. A characteristic histological feature is the presence of thin-walled, broad, often septate hyphae or hyphal fragments with a thick eosinophilic sheath, frequently phagocytosed within giant cells. The fungus is known to produce in vitro several enzymes, e.g., elastase, esterase, collagenase and lipase, which have a possible role in pathogenicity. A concentrated brain heart infusion culture filtrate antigen is useful for immunodiagnosis. Several drugs e.g., potassium iodide, cotrimoxazole, amphotericin B, ketoconazole and itraconazole have been tried with varying success. Investigations on the immunology of disease and the role of proteases and lipases in the pathogenesis of infection is an important area of further research.

Nasal carriage of Staphylococcus aureus in hospital staff and its antibiotic sensitivity in Enugu, Nigeria

The nasal carriage of Staphylococcus aureus was investigated in 475 hospital staff of different categories. The overall carriage was 34.42 per cent with a significantly higher rate in females (67.53 per cent) than in males (23.81 per cent). Nurses, orderlies and attending physicians had a higher carriage rate than other categories of staff investigated. The rate was higher in personnel working in accident, neonatal and postnatal wards than in other wards. As many as 51.94 per cent of the strains of S. aureus were resistant to penicillin while 22.72 per cent of them were resistant to ampicillin.